The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis

Effect of an adapted physical activity program in Parkinson's disease: A randomized controlled study (APA-Park)

CONTEXT

Previous studies assessing adapted physical activity (APA) in Parkinson's disease (PD) have been very heterogeneous regarding methodology and intervention, and have generally not addressed the question of combining various types of physical activity with a long-term evaluation.

OBJECTIVES

To evaluate the immediate and long-term effect of a 3-month APA program, combining endurance, resistance training and stretching on motor symptoms, body composition, cardiorespiratory function and metabolic profile in PD patients.

METHODS

In this controlled trial, we randomly assigned forty-four PD patients in a 1:1 ratio to receive a 3-month APA program (APA + group, n = 22), or freely practice physical activity (APA- group, n = 22). The patients were evaluated for parkinsonian symptoms (UPDRS-III), body composition, cardiorespiratory function and metabolic profile at baseline, immediately after the end of the program (M3) and six months later (M9).

RESULTS

Between baseline and M3, the mean UPDRS-III score decreased in PD patients from the APA + group whereas it increased in the APA- group (-1.2 ± 6.6 vs. +1.9 ± 8.9; p = 0.04), regardless of age, sex, disease duration, dopaminergic treatment, UPDRS-III and axial score at baseline, but these between group differences waned at M9. No between group difference was observed regarding the evolution of body composition, metabolic profile or cardiorespiratory function between baseline, M3 and M9.

CONCLUSION

A 3-month APA program combining endurance and resistance training plus stretching is more efficient for improving motor symptoms in PD compared to an unstructured engagement in non-specific physical activities. However, the benefits fade away six months after discontinuation of the program.

STATISTICAL ANALYSIS CONDUCTED BY

LAMBERT Céline, CHU Clermont-Ferrand, DRCI, Biostatistics Unit, Clermont-Ferrand, FRANCE.

REGISTRATION NUMBER

clinicaltrials.gov number NCT02816619.

Traditional Chinese exercises for the treatment of neuropsychiatric symptoms in Parkinson's disease: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the efficacy of traditional Chinese exercises (TCEs) for neuropsychiatric symptoms (NPSs) in patients with Parkinson's disease.

METHODS

A comprehensive literature search was performed across eight databases, including PubMed, Cochrane Library, Embase, Web of Science (WoS), SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Periodical Database (VIP), and Wanfang Database, covering studies published from their inception up to April 23, 2024. The search focused on identifying randomized controlled trials (RCTs) assessing the effectiveness of TCEs for NPSs in PD patients. The authors independently performed literature screening and data extraction. Meta-analysis was executed employing Review Manager V.5.3 software, and Stata 17.0 was used to detect publication bias and perform sensitivity analysis. GRADEpro GDT was used to grade the certainty of each outcome evidence.

RESULTS

Eighteen studies involving 937 participants were included. The meta-analysis showed significant improvements in depression-related scales (standardized mean difference (SMD) = -1.30, 95 % confidence interval (CI): -2.10 to -0.49, p = 0.002), anxiety-related scales (SMD = -1.11, 95 %CI: -2.14 to -0.08, p = 0.03), sleep disorder-related scales (SMD = -0.71, 95 %CI: -0.99 to -0.43, p < 0.00001), and cognition-related scales (SMD = 0.91, 95 %CI: 0.44-1.38, p = 0.0001). Quality of life also improved (SMD = -1.35, 95 % CI: -2.38 to -0.31, p = 0.01; SMD = 0.99, 95 % CI: 0.54-1.43, p < 0.0001). Subgroup analyses grounded in the duration of the intervention suggested that interventions lasting up to 12 weeks showed more significant anti-depression and anti-anxiety effects while those lasting beyond 12 weeks demonstrated greater improvements in sleep quality and cognitive function. Additionally, subgroup analyses based on the type of intervention revealed that both using TCEs alone and the combination of TCEs with conventional medications showed greater effects on anti-depression and cognitive function, while the latter yield more significant anti-anxiety effects. However, no statistical significance was found for fatigue-related scales. The clinical trials included in this review also lacked a thorough description of the randomization process, and only a small proportion reported adequate allocation concealment procedures, raising concerns about potential selection bias. Moreover, owing to the inherent characteristics of TCEs, blinding both participants and practitioners is challenging, which may result in performance bias. Additionally, the absence of blinding could allow assessors' subjective influences to affect the outcomes, leading to detection bias. The overall quality of the evidence, as assessed according to the GRADE criteria, was rated as very low or low for most of outcomes.

CONCLUSIONS

The findings indicated that the use of TCEs may have potential to alleviate the severity of NPSs including depression, anxiety, sleep disorders, and enhance cognition function and overall quality of life in PD patients. Nevertheless, given the limited number of studies and their methodologic issues such as the absence of blinding, along with the small sample sizes, significant heterogeneity across these primary studies, careful interpretation of the results is warranted. More high-quality research with larger sample sizes, including double-blind studies or those employing an active control group involving exercises such as walking, ought to be carried out to validate the above findings and strengthen the evidence base.

REGISTRATION

PROSPERO: CRD42024540164.

The effects of stretching in Parkinson's disease: A systematic review of randomized controlled trials

INTRODUCTION

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms. While incurable, exercise has shown therapeutic benefits. Stretching, an accessible and low-cost modality, may improve mobility, balance, and flexibility, warranting systematic evaluation for managing PD symptoms. This systematic review aimed to examine and critically analyze scientific evidence on the effects of stretching in people with Parkinson's disease.

METHODS

A search was conducted in four electronic databases (Scopus, Web of Science, PEDro, and MEDLINE/PubMed) from inception to November 2024. The methodological quality of included studies was assessed using the PEDro scale.

RESULTS

Twelve randomized controlled trials were analyzed. Stretching programs lasted 4 weeks to 6 months. Positive effects were observed in motor symptoms and functional mobility for people with PD, although these were generally less pronounced compared to interventions like Tai Chi or WuQinXi Qigong. In contrast, mixed results to no significant improvements were observed for balance, gait, strength, cardiorespiratory fitness, mental health, neurocognitive function, sleep quality, physical activity levels, and fatigue.

CONCLUSION

Stretching improves motor symptoms and mobility in people with PD, but its benefits for gait, motor function, and mental health are limited compared to other exercises. Further studies are needed to assess its impact on motor and neurocognitive functions.

Impact of Tai Chi Therapy on Fatigue and Cognitive Function in Individuals With Chronic Fatigue Syndrome: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Chronic fatigue syndrome (CFS) is a psychosomatic disorder characterized by persistent fatigue, primarily involving physical and mental exhaustion, with greater emphasis on the latter. This leads to a deterioration in concentration and memory. These symptoms affect cognitive functions, including attention and memory, to varying degrees. Previous research has shown that Tai Chi can help reduce fatigue in individuals with CFS. However, the relationship between alleviating CFS-related fatigue through Tai Chi and its impact on cognitive functions remains unclear. The effects of Tai Chi on cognitive functions in individuals with CFS have not been clinically validated, and its efficacy and safety have yet to be examined through large-scale randomized controlled trials. Therefore, this protocol outlines a pilot randomized, parallel, single-blind clinical trial designed to evaluate the impact of Tai Chi therapy on fatigue and cognitive functions in individuals with CFS, using both subjective and objective assessments.

OBJECTIVE

This pilot study aims to explore the preliminary efficacy and safety of Tai Chi in reducing fatigue and improving cognitive function in patients with CFS, and to generate data to inform future large-scale trials.

METHODS

We will conduct a randomized, analyst-blinded, parallel-controlled trial with a 12-week intervention period and a 4-week follow-up. Enrolled patients will be randomly assigned to either the Tai Chi group (30 patients) or the health education group (30 patients). The Tai Chi group will receive the 24-style simplified Tai Chi intervention, while the control group will receive a health education intervention. Following the 12-week intervention, a 4-week follow-up will be conducted. The Tai Chi group will train 3 times per week, consisting of 2 in-person sessions at the Physical Education Center of Shanghai University of Traditional Chinese Medicine and 1 self-directed session guided online by an instructor. The primary outcome measure is the 20-item Multi-Dimensional Fatigue Inventory (MFI-20). The secondary outcome measures include the Montreal Cognitive Assessment (MoCA), Pittsburgh Sleep Quality Index (PSQI), Attention Network Test (ANT), working memory performance (N-Back task), and magnetic resonance imaging.

RESULTS

The research protocol and informed consent form were approved by the Shanghai Clinical Research Ethics Committee on March 18, 2024 (approval number SECCR2024-22-01). Participant recruitment began in April 2024. All interventions and concurrent data collection will be completed by October 2025, and the 4-week postintervention follow-up assessments will be finalized by the end of October 2025. Data management is still ongoing; therefore, data analysis has not yet been performed.

CONCLUSIONS

As a pilot trial, the findings of this study will provide preliminary clinical evidence on the role of Tai Chi in improving cognitive function in patients with CFS and will serve as a foundation for designing future large-scale trials.

TRIAL REGISTRATION

China Clinical Trials Registry ChiCTR2400082268; https://tinyurl.com/2tkr7j7x.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/65958.

"Dance Well"-A Multisensory Artistic Dance Intervention for People with Parkinson's Disease: A Pilot Study

Background/Objectives: Parkinson's disease (PD) is a complex neurodegenerative disorder responsible for both motor and non-motor disturbances impairing motor behavior. This complexity necessitates integrated, multidisciplinary, and comprehensive models of care. A new and interesting complementary approach is represented by "Dance Well", i.e., an artistic, multisensory dance intervention based on art and music. This pilot study aims to evaluate the efficacy, feasibility, and safety of a 4-week Dance Well (DW) program in PD patients in early-medium disease stages. Methods: Twenty-four PD patients (H&Y ≤ 3; MoCA score ≥ 13.8) were enrolled and randomly allocated into two groups, both with a twice-per-week frequency and lasting 4 weeks: one group underwent the DW program, while the other underwent conventional physiotherapy (CPT). Demographic, biometric, and clinical data were collected. To study the treatment effect, motor (Unified PD Rating Scale-III, Timed Up and Go Test, Berg Balance Scale, 6-Minute Walk Test, and Falls Efficacy Scale), cognitive (Corsi Supra Span Test, Trail Making Test A and B-A), and emotional-motivational (Beck Depression Inventory, State-Trait Anxiety Inventory, Apathy Evaluation Scale) outcome measures were assessed, before and after the rehabilitation program. To study treatment compliance and safety, the number of dropouts and any adverse events (such as injuries and falls) were recorded. Results: All outcome measures improved in both groups. The percentage of improvement in outcome measures assessing attention and motivation was greater in the DW group. No dropouts, falls, or injuries occurred. Conclusions: In the early-medium stages of PD, DW could be considered a feasible and safe complementary treatment, useful in improving motor, cognitive, and emotional-motivational symptoms.

The Science of Tai Chi and Qigong and Whole Person Health Part I: Rationale and State of the Science

The emerging paradigm of whole person health shares many core principles with traditional complementary and integrative health frameworks, including Tai Chi and qigong (TCQ). In the Fall of 2023, the Harvard Medical School Osher Center for Integrative Health hosted the inaugural international conference on The Science of Tai Chi for Whole Person Health: Advancing the Integration of Mind-Body Practices into Contemporary Health Care held at Harvard Medical School. A two-part white paper was written to summarize key conference topics, findings, and issues. Part I presented here summarizes the rationale for the conference and synthesizes the state of evidence for TCQ as rehabilitative and preventive tools for a range of clinical conditions, including falls and balance, cognition, mental health, sleep, cardiorespiratory health, musculoskeletal health, cancer, as well as translational evidence related to the neurophysiology, brain and immune function, and biomarkers of inflammation. The state of science of TCQ, viewed through the lens of traditional East Asian health constructs, is also discussed. Part II of this white paper outlines evidence gaps and opportunities and discusses strategies to address challenges in TCQ research, dissemination, and implementation.

Effect of qigong on pain and disability in patients with chronic non-specific low back pain: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Chronic non-specific low back pain (CNLBP) is a common health problem worldwide. Patients with CNLBP often suffer from persistent pain, with a few being disabled by their pain, affecting their daily functioning and social participation. This study aims to systematically evaluate the effects of pain and dysfunction in Qigong patients with chronic non-specific back pain through systematic evaluation and gathered analysis of random control test data.

METHODS

We searched nine databases from their inception dates until April 2024. Relevant randomized controlled trials (RCTs) were included. Patients were assessed for pain using the Visual Analog Scale and Numeric Pain Rating Scale and for disability using the Oswestry Disability Index and Roland-Morris disability questionnaire. The risk of bias was assessed using the Cochrane Collaboration tool. CMA V3.0 was used to analyze data.

RESULTS

Sixteen RCTs involving 1175 participants were included. These studies have different designs, and the participants are mainly around 60 years old. The results showed that the qigong practice improved pain significantly more than the control measures ([Mean Difference MD] = - 1.34, 95% confidence intervals [CI] - 1.76 to - 0.92, p < 0.001 Minimal Clinically Important Differences MCID = 1.5), and the efficacy of short-term interventions (MD = - 1.88, 95% CI - 2.87 to - 0.9, p < 0.001) was superior to that of long-term interventions (MD = - 1.07, 95% CI - 1.49 to - 0.65, p < 0.001). For improvement in the degree of dysfunction, qigong practice showed a higher effect size (MD = - 5.88, 95% CI - 7.98 to - 3.78, p < 0.001 MCID = 5) than that observed in the control group.

CONCLUSION

Qigong practice is effective in improving disability in patients with CNLBP, but has no significant effect on improving pain. However, due to the high heterogeneity, the results need to be interpreted with caution.

Tai Chi improves balance, mobility and gait function of the lower limbs in patients with Parkinson's disease: a systematic review and meta-analysis

OBJECTIVE

This study aimed to systematically evaluate the effect of Tai Chi on the balance function, mobility function, and gait function (including gait endurance, gait amplitude, and gait speed) of the lower limbs in patients with Parkinson's disease.

METHODS

The "PICOS" principle was used to search seven English and six Chinese databases. Search for relevant studies published up to September 11, 2023, from the date of database creation. Two authors independently screened all eligible studies. The included studies were assessed for risk of bias based on the criteria outlined in Cochrane Handbook 5.1.0. Quantitative statistics and meta-analyses were conducted using Review Manager 5.4 software.

RESULTS

Th 18 studies that met the inclusion criteria, 16 of which were included in the meta-analysis, included a sample of 963 cases from four countries. The meta-analysis revealed that Tai Chi was effective compared with conventional medication in improving balance function (MD = 2.06, 95% CI [1.35, 2.78], P < 0.00001, I2 =0%), mobility function (MD = - 1.59, 95% CI [- 2.28, - 0.91], P < 0.00001, I2 =14%), and gait speed (SMD =0.59, 95% [0.28, 0.91], P = 0.0002, I2 =29%). However, there was no significant improvement in gait endurance (SMD = 0.14, 95% CI [-0.41, 0.68], P =0.62, I2 = 0%) or gait amplitude (SMD =0.30 , 95% CI [- 0.00, 0.61], P = 0.05, I2 =0%). Compared with other exercise therapies, Tai Chi was significantly superior in improving balance function (MD = 3.05, 95% CI [1.94, 4.16], P <0.00001, I2 = 38%), mobility function (MD =-0.70, 95%CI [- 1.23, - 0.17], P = 0.01, I2 = 0%), and gait range (SMD = 0.36, 95% CI [0.14, 0.58], P = 0.002, I2 = 45%). However, the advantage of improving gait speed (SMD =0.00, 95% CI [- 0.28, 0.29], P = 0.98, I2 =0%) was uncertain.

CONCLUSION

Tai chi is a safe and effective rehabilitation intervention that can enhance the balance and mobility functions of the lower limbs in patients with Parkinson's disease.

Effect of group exercise on quality of life for Parkinson disease: systematic review and meta-analysis

PURPOSE

Motor and non-motor symptoms can negatively affect quality of life (QoL) for people with Parkinson Disease (PD). Our purpose was to investigate the effects of group exercise (GE) compared to individual exercise (IE) and usual care (UC) on QoL for people with PD. A systematic review and meta-analysis were performed with randomized controlled trials that studied the effects of GE compared to IE and UC on QoL for people with PD.

MATERIALS AND METHODS

The systematic search was performed in EBSCO, PubMed, and Science Direct databases. Quality of methodology was assessed using the Cochrane GRADE approach. Thirteen studies met all inclusion criteria and were included in the analysis.

RESULTS

No significant difference was found on QoL between GE and IE; however, QoL was significantly improved with GE compared to UC. Results were based on low to moderate quality of evidence.

CONCLUSIONS

Based on low to moderate quality of evidence, GE has a similar effect on QoL when compared to IE and has a small and statistically significant effect when compared to UC, regardless of the patient reported outcome measure used or the total volume of exercise prescribed. GE may be an appropriate option for people with PD to improve their QoL.

Integrating deliberate shaking into daily living: a paradoxical exercise for Parkinsonian tremor

PURPOSE

Medication often falls short in controlling tremors in Parkinson's disease. While physical activities suggest potential benefits, current exercise regimes have limitations. This paper explores the concept of deliberate shaking as an intervention to aid exercise uptake and potentially leverage synergies between medication and physical activity. It examines the rationale for and mechanisms of deliberate shaking before exploring its further examination and implementation for tremor rehabilitation.

METHOD

This conceptual article draws on relevant literature using the SANRA guide to explore the potential of deliberate shaking to relieve tremors in Parkinson's disease.

RESULTS

Deliberate shaking is a controlled exercise where an individual consciously initiates and partially surrenders to rhythmic movements while maintaining the ability to stop at will. Integrated into daily activities, this practice may target and stimulate specific muscle groups. It may alleviate tremor through various mechanisms: neurobiological, physiological, and cognitive and psychological. Before implementation, empirical research is needed to assess its feasibility, safety, and effectiveness. Implementation requires assessing eligibility for a shaking prescription, setting personalized goals, providing guidance as needed, and ensuring appropriate safety measures are in place.

CONCLUSIONS

Deliberate shaking is a potential adjunct treatment for Parkinsonian tremor. However, it requires further testing.

Optimal dose and type of exercise improve walking velocity in adults with Parkinson's disease: a systematic review and Bayesian network meta-analysis

To examine the dose-response relationship between specific types of exercise for improving walking velocity in Parkinson's disease (PD). This systematic review and network meta-analysis included searches of PubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science were searched from inception until February 18th, 2024. Data analysis was performed using R software with the MBNMA and RJAGS packages. Outcome indicators were measured as mean standard deviation (SMD) along with 95% confidence intervals (95% CrI). The network's risk of bias was independently evaluated by two reviewers employing the ROB2 tool. Our review encompassed 54 studies with 2,828 PD patients, examining the dose-response effects of different exercises on walking velocity. Aerobic Exercise (AE) demonstrated the greatest improvement at an optimal dose of 1,400 METs-min/week (SMD:1.215, 95% Crl: 0.113 to 2.306). Both Multicomponent Exercise (Mul) (SMD: 1.202, 95% Crl: 0.193 to 2.231) and Sensory Exercise (SE) (SMD: 0.649, 95% Crl: 0.139 to 1.183) showed optimal outcomes at a dose of 1,000 METs-min/week. Resistance Training (RT) was most effective at 750 METs-min/week (SMD:0.778, 95% Crl: 0.062 to 1.549), while Mind-Body Exercise (MBE) yielded significant improvements at a lower optimal dose of 500 METs-min/week (SMD: 0.580, 95% Crl: 0.218 to 1.137), offering valuable insights for exercise prescription in PD management. Various types of exercise showed specific optimal benefits at corresponding doses, among which AE was the most effective in improving the walking speed of PD patients at 1,400 Mets*min/week.Trial registration: PROSPERO (CRD42024506919).

Effects of Tai Chi and Qigong on physical function and psychiatric symptoms among individuals with mental illness: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Tai Chi and Qigong (TCQ) can be a non-pharmacological intervention for individuals with mental illness, improving physical function and mental health.

PURPOSE

This meta-analysis investigated the effects of TCQ on physical function and psychiatric symptoms in adults with schizophrenia or mood disorders.

METHODS

Randomized clinical trials on the effect of TCQ on physical function or psychiatric symptoms in individuals with mental illness, published in English, Korean, or Chinese, were included. A systematic search of 17 electronic databases up to September 2024 was conducted. The risk of bias was assessed using Cochrane RoB 2.0. Data were analyzed through meta-analysis, subgroup analysis, and meta-regression.

RESULTS

Nineteen randomized studies (n = 1243, mean age 53 years) reported outcomes on physical function (k = 11) and psychiatric symptoms (k = 18). The risk of bias assessment showed that 21.1% of studies had a low risk, 73.7% had some concerns, and 5.3% had a high risk. TCQ significantly improved physical function (Hedges' g = 0.53, 95% CI, 0.26-0.81) and psychiatric symptoms (Hedges' g = 0.63, 95% CI, 0.41-0.85) in individuals with serious mental illness (SMI), regardless of intervention duration and comparison type. TCQ showed no significant effect on physical function in individuals with schizophrenia but demonstrated a significant moderate effect in those with mood disorders (Hedges' g = 0.56, 95% CI, 0.32-0.80). TCQ significantly improved psychiatric symptoms in both groups (schizophrenia: Hedges' g = 0.64, 95% CI, 0.26-1.02; mood disorders: Hedges' g = 0.64, 95% CI, 0.33-0.96). Meta-regression indicated that the effects of TCQ on physical function covaries with those on psychiatric symptoms among individuals with SMI (Q = 21.43, df = 9, P = .011).

CONCLUSIONS

TCQ effectively enhances physical function and psychiatric symptoms in individuals with schizophrenia or mood disorders. These findings support TCQ as an effective non-pharmacological intervention for individuals with SMI. Further studies should explore the underlying mechanisms by which TCQ improves psychiatric symptoms through physical function, leading to the development of targeted intervention strategies in this population.*PROSPERO international prospective register of systematic reviews, registration ID CRD42024581253.

Effects of Tai Chi on physical performance, sleep, and quality of life in older adults with mild to moderate cognitive impairment

BACKGROUND

Exercise is a promising nonpharmacological intervention to delay the progression of cognitive impairment and improve physical function and sleep quality in patients, but the evidence remains inconclusive.

AIMS

To compare the therapeutic efficacy of an exercise intervention on physical performance, sleep efficiency, and quality of life in older adults with cognitive impairment.

DESIGN

A three-arm randomized controlled trial.

METHODS

This study recruited 81 older adults with mild to moderate cognitive impairment at a nursing home from December 2020 to July 2021. Participants were screened and randomized into three groups: a tai chi intervention group (n = 27), a conventional exercise intervention group (n = 27), and a waitlist control group with no intervention (n = 27). The intervention groups underwent 12 weeks of exercise intervention. Participants were assessed at weeks 0, 6, and 12. The primary outcome was the Short Physical Performance Battery score, and the secondary outcomes were sleep efficiency and quality of life. Statistical analysis was conducted with generalized estimating equations (GEEs).

RESULTS

The mean age of the participants was 81.0 ± 7.4 years. The GEE analysis revealed that the Short Physical Performance Battery score, sleep efficiency, and quality of life were significantly higher in both intervention groups than in the control group at week 12, and physical performance improved significantly more in the tai chi group than in the conventional exercise group.

CONCLUSIONS

Both exercise interventions improved physical performance, sleep efficiency, and quality of life in older adults with mild to moderate cognitive impairment. According to our results, tai chi may be a more effective therapeutic approach for cognitive impairment than conventional exercise.

TRIAL REGISTRATION

University Hospital Medical Information Network number UMIN000042051. Registered 01/12/2020.

Tai Chi and Wellness Interventions for Veterans with Gulf War Illness: A Randomized Controlled Feasibility Trial

BACKGROUND

Gulf War Illness (GWI) is a chronic multi-symptom illness that affects up to one-third of the 700,000 American military personnel deployed to the Persian Gulf region in 1990 and 1991. We conducted a randomized controlled trial to examine feasibility and the relative efficacy of two 12-week in-person group treatments (Tai Chi and Wellness) to address GWI symptoms of chronic pain, fatigue, and changes in mood and cognitive functioning.

METHOD

Male and female veterans were randomly assigned to Tai Chi (n = 27) or Wellness (n = 26) group interventions and assessed at four time points: baseline, post-treatment, 3-, and 9-month follow-up. Multilevel models with a treatment-by-time interaction term were utilized to evaluate treatment effects and changes in GWI-related outcomes over time.

RESULTS

Satisfaction was high, there were no adverse events, and over half the participants attended 75% or more sessions with no significant differences between groups. For pain interference, analyses revealed a significant quadratic effect of time with no differences between treatment groups. For general fatigue and a cognitive test of trail making, no significant effects were detected. For depressed mood, linear and quadratic time effects and the group x linear time interaction were significant indicating greater reductions for Tai Chi participants. For a verbal learning test, linear and quadratic time and the group x quadratic time interaction significantly predicted total recall with Tai Chi participants demonstrating more rapid initial improvements.

CONCLUSION

Findings indicate that both Tai Chi and Wellness are feasible and acceptable. Both interventions may have a salutary impact on pain interference, depression, and verbal learning with some advantages for Tai Chi.

Guideline "Parkinson's disease" of the German Society of Neurology (Deutsche Gesellschaft für Neurologie): concepts of care

INTRODUCTION

In 2023, the German Society of Neurology published a new guideline on Parkinson's disease. An important section dealt with PD care concepts, which represent a particularly dynamic field of PD research, including their implementation in clinical practice. Parkinson's disease is the second most common age-associated neurodegenerative disease. Current estimates of the number of cases in the population describe a significant increase in prevalence in Germany by 2030 with higher proportions in rural areas, which also have a lack of sufficient PD care resources.

RECOMMENDATIONS

In comparison with other international guidelines, which have so far mentioned palliative care and Parkinson's nurses in particular, the German S2k guideline expands the recommended concepts of PD care to include PD day clinics, inpatient complex treatment, and PD networks.

CONCLUSION

Concepts of PD care guidelines are necessary because of the complex and rapidly evolving field of PD care provision. If applied appropriately, the potential for optimized care can be exploited and both the patient burden and the economic burden can be reduced. Given that modern care concepts have so far only been applied in a few regions, it is often impossible to generate broad evidence-based data, so that the evaluation of PD care concepts is partly dependent on expert opinion.

Effects of long-term adapted physical training on functional capacity and quality of life in older adults with Parkinson's disease

Background

Parkinson's disease (PD) remains incurable and its prevalence is increasing as the population ages. Although physical activity is considered a therapeutic treatment to slow the progression of the disease, it is considered to be an effective non-pharmacological adjuvant to medication to improve the symptom management.

Methods

The training program was offered for all the participants (N = 50) in three non-consecutive sessions per week for 60 minutes and a total duration of 12 to 16 months. Each session is composed of warming up, adapted boxing training exercises, muscle building and resistance exercises, and returning to calm. For the measurement of physical capacities, the following tests were administered: the Fullerton Advanced Balance Scale (FAB), Timed Up and Go (TUG), and the 30-second chair lift test (TLC30). With regard to quality of life, the Parkinson's Disease Questionnaire of 39 questions (PDQ-39) was used. The participants (age range from 60 to 80 years) were divided following the results of the Parkinson disease severity (Questionnaire Hoehn and Yahr; H&Y) into two groups (H&Y 1-2: mild to moderate symptoms; H&Y 3-4: moderate to severe symptoms).

Objective

The aim of this research was to assess the long-term effects (12 to 16 months) of a community-wide adapted physical program on the physical capacity and quality of life of people with Parkinson disease.

Conclusion

In view of the results, adapted physical training appears to be beneficial for physical capacity and life quality and considered to be an important approch for maintaining the physical and mental capacities and slowing down the proression of neurodegenrative disease.

Assessment of Personalized Exercise Prescriptions Issued by ChatGPT 4.0 and Intelligent Health Promotion Systems for Patients with Hypertension Comorbidities Based on the Transtheoretical Model: A Comparative Analysis

Purpose

Exercise is a vital adjunct therapy for patients with hypertension comorbidities. However, medical personnel and patients face significant obstacles in implementing exercise prescription recommendations. AI has been developed as a beneficial tool in the healthcare field. The performance of intelligent tools such as ChatGPT 4.0 and Intelligent Health Promotion Systems (IHPS) in issuing exercise prescriptions for patients with hypertension comorbidities remains to be verified.

Patients and Methods

After collecting patient information through IHPS hardware and questionnaire systems, the data were input into the software terminals of ChatGPT 4.0 and IHPS according to the five stages of the Transtheoretical Model, resulting in exercise prescriptions. Subsequently, experts from various fields scored the accuracy, comprehensiveness, and applicability of each prescription, along with providing professional recommendations based on their expertise. By comparing the performance of both systems, their capability to serve this specific group was evaluated.

Results

In most cases, ChatGPT scored significantly higher than IHPS in terms of accuracy, comprehensiveness, and applicability. However, when patients exhibited certain functional movement disorders, GPT's exercise prescriptions involved higher health risks, whereas the more conservative approach of IHPS was advantageous.

Conclusion

The path of generating exercise prescriptions using artificial intelligence, whether via ChatGPT or IHPS, cannot achieve a completely satisfactory state.But can serve as a supplementary tool for professionals issuing exercise prescriptions to patients with hypertension comorbidities, especially in alleviating the financial burden of consulting costs. Future research could further explore the performance of AI in issuing exercise prescriptions, harmonize it with physiological indicators and phased feedback, and develop an interactive user experience.

Relationships between physical activities performed under free-living conditions and non-motor symptoms in people with Parkinson's: A systematic review and meta-analysis

BACKGROUND

Physical activities performed under free-living conditions that are unsupervised in the home or community have the potential to modulate non-motor symptoms in people with Parkinson's disease.

OBJECTIVE

This systematic review investigates the relationships between physical activities performed in free-living conditions and non-motor symptoms in people with Parkinson's disease: cognition, anxiety, apathy, depression, sleep disturbances, fatigue, and pain.

DATA SOURCES

A database search was performed on Scopus, Web of Science, Ovid (PsycINFO), CINAHL, PubMed, and ProQuest (Health and Medicine).

REVIEW METHODS

Observational studies published from 2000 to 2024 that examined the relationships between physical activity and non-motor symptoms were included. The methodological quality of reports was evaluated using critical appraisal checklists appropriate to the study design. Where appropriate, a meta-analysis was conducted to combine data from the included articles.

RESULTS

A total of 14 articles met the criteria and used various tools to evaluate non-motor symptoms and physical activity. Meta-analyses showed that people with Parkinson's who are more physically active have better global cognition [β ranged from 0.12 to 0.28; p = 0.00-0.02] and less affective disorders [β -0.20, p = 0.00]. Increased physical activity levels were also associated with better sleep quality (n = 1) and less chronic pain (n = 1). The overall methodological quality of the included articles was considered high.

CONCLUSION

Engagement in increased levels of physical activities performed under free-living conditions is associated with better cognition and less anxiety, apathy, and depression in people with Parkinson's disease.

German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions

BACKGROUND AND OBJECTIVE

Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson's disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on "Parkinson's disease" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders.

METHODS

The recommendations were based on literature reviews, other relevant guidelines, and expert opinions.

RESULTS

Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson's disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety.

CONCLUSIONS

In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.

The relationship between square dance exercise and quality of life in middle-aged and older adults: chain mediated effects of negative emotions and attitudes toward aging

Background

With the continuous development of society and the economy, population aging has become an inevitable global development trend, triggering a series of social problems and having a more serious impact on the physical and mental health of middle-aged and older adults. Physical exercise is one of the key factors for improving the overall health and quality of life of individuals, but the role of square dance exercise and the quality of life of middle-aged and older adults have not yet been clarified.

Purpose

This study aimed to investigate the associations between square dance exercise and the quality of life of middle-aged and older adults and its mechanism of action, including its effects on physical health and mental health, with negative emotions and attitudes towards aging as mediating variables.

Method

This study adopted a cross-sectional research method, using the Physical Activity Rating Scale (PARS-3), Depression-Anxiety-Stress Scale in Simplified Chinese (DASS-21), Attitudes toward Aging Questionnaire (AAQ), and 12-item Short Form of the Health Survey (SF-12), and launched an online survey on the QuestionStar platform from August-September 2023 for 4,636 middle and older adults aged 45-74 years. The survey results were analyzed via Pearson correlation analysis via SPSS 27.0 and structural equation modeling analysis via Mplus 8.3 to test the model fit and mediation effects.

Results

Square dance exercise was significantly correlated with negative emotions, attitudes towards aging, and quality of life (r = -0.042-0.878, p < 0.01). Square dance exercise significantly and positively predicted quality of life (β = 0. 202, p < 0.001). Negative emotions and attitudes towards aging are chain mediators of square dance exercise and quality of life, and the mediation consists of three pathways: separate mediation of negative emotions, separate mediation of attitudes towards aging, and chain mediation of negative emotions-attitudes towards aging.

Conclusion

This study is dedicated to deepening the scientific role of how square dancing, as a health-promoting activity, can optimize the quality of life of middle-aged and older adults through the mediating mechanism of negative emotion alleviation and positive attitudes towards aging and then optimize the quality of life of middle-aged and older adults. This process not only enriches the theoretical framework of the complex interactions between psychosocial factors and healthy aging but also provides a solid empirical foundation for the development of health intervention strategies aimed at enhancing the overall well-being and quality of life of the middle-aged and older adults.

Effects of Tai Chi and Qigong on Heart Rate Variability: A Systematic Review and Meta-Analysis

Background:

Intervention studies examining meditative movement (MM) often demonstrate benefits on physiological and psychological health. A potential mechanism associated with these outcomes is heart rate variability (HRV), an important neurophysiological biomarker of optimal and resilient health and functioning.

Objective:

We aimed to synthesize existing literature on the effects of two related forms of MM, Tai Chi (TC) and Qigong (QG) on HRV parameters in adult populations.

Methods:

Following PRISMA guidelines and Cochrane Collaboration recommendations, four databases (MEDLINE, Google Scholar, Academic Search Premier, and PubMed) were searched for articles (through December 15, 2023) that included TC and/or movement-based QG intervention versus any control condition (active or inactive) and reported at least one HRV outcome. Two reviewers independently completed study selection, data extraction, and risk-of-bias assessment.

Results:

We identified 148 for potential inclusion. After removing 61 duplicates, 87 full-text reviews yielded 23 articles, and 16 qualified for meta-analysis based on common HRV outcomes. Meta-analyses indicated a significant overall effect of TC/QG interventions on high-frequency power and standard deviation of the beat-to-beat intervals (SDNN), two critical HRV parameters, compared with control conditions: for HF power, standardized mean difference (SMD) = 0.29, P = 0.003, 95% Confidence interval (CI) [0.10, 0.48]; heterogeneity: I 2 = 46%, χ2 (8) = 14.89, P = 0.06; and for SDNN: SMD = 0.83, P = 0.02, 95% CI [0.16, 1.51]; heterogeneity: I 2 = 90%, χ2 (7) = 71.62, P < 0.001. Other HRV parameters did not demonstrate significant changes upon meta-analyses, but overall effect sizes showed a trend toward the expected direction.

Conclusion:

Based on the strength of the evidence, we conclude TC/QG interventions may shift HRV parameters toward improved health status and resilience. In addition, we offer suggestions to improve the design and measurement of future TC/QG research interventions exploring HRV.

Mindfulness in Parkinson's disease: A French national survey and a pilot intervention feasibility trial using the MBSR program (M-Park)

BACKGROUND

Non-pharmacological complementary interventions, particularly mind-body practices, are of growing importance in the management of Parkinson's disease (PD). Among these, mindfulness meditation seems particularly effective, especially on anxiety and depression symptoms. However, current knowledge on mindfulness standardized programs in PD is still limited, particularly in France. Aiming at improving this knowledge we designed the M-PARK study in two phases. Phase 1 consisted in a French national survey to explore expectations, needs and initiatives for mindfulness meditation for PD patients. Phase 2 was a clinical trial with objectives to assess feasibility, acceptability and effects of a mindfulness (MBSR) program proposed to PD patients.

METHODS

In phase 1, online questionnaires were addressed to members of a French PD patient's association (France Parkinson) and French MBSR qualified instructors. In Phase 2, a clinical trial involving 30 PD patients consisted of a standard MBSR program with two additional evaluation visits one month before and after the program. Data collection included a global clinical evaluation, assessment of depression and anxiety symptoms, sleep, pain and quality of life and a face-to-face interview for qualitative assessment of the acceptability and lived experience during the program. Three MBSR programs were proposed to three groups of ten patients: two were online due to the pandemic situation, one proposed to patients with no or minor fluctuations (group 1) and one for patients with slight to moderate fluctuations (group 2), and the last one face-to-face for patients with no or minor fluctuations (group 3).

RESULTS

French survey: 209 responses were collected for the questionnaire sent to the members of the association France Parkinson; and 68 for the questionnaire sent to the instructors. Two-thirds of patients surveyed had heard of mindfulness meditation (66%), but were unaware of what this approach really consisted and how it could really help them. Few instructors (29%) had had to deal with patients with PD in their current practice. Yet 90% of patients surveyed indicated they were in favor of introducing this type of approach into their care.

CLINICAL TRIAL

The results indicated that the program is feasible and acceptable both online and face-to-face for patients with PD. Among the 30 patients enrolled, 25 completed the program. No unwanted effects related to mindfulness meditation practice were observed. The results showed a statistically significant reduction in anxiety symptoms, depressive symptoms, and improvement in quality of life. Furthermore, no statistically significant change was measured for pain or sleep quality. There was no striking difference in results observed between the patient groups. For the qualitative analysis, major themes highlighted were in relation with: (i) the lived experience during program; (ii) changes in the daily life; and (iii) disease-related changes. A large majority of patients who completed the program (24/25) described their participation as positive or very positive. They reported better management of stress and emotions, as well as greater autonomy in implementing new behavioral strategies, particularly in terms of self-care, acceptance, and de-identification from the disease.

CONCLUSION

Despite high expectations, PD patients are poorly informed about available mindfulness programs. This study however shows that these programs, whether offered online or face-to-face, are particularly beneficial, especially for anxiety and depressive symptoms, at least in mild-to-moderate stages of the disease.

Differences in brain connectivity between older adults practicing Tai Chi and Water Aerobics: a case-control study

Background

This study aimed to investigate the neural mechanisms that differentiate mind-body practices from aerobic physical activities and elucidate their effects on cognition and healthy aging. We examined functional brain connectivity in older adults (age > 60) without pre-existing uncontrolled chronic diseases, comparing Tai Chi with Water Aerobics practitioners.

Methods

We conducted a cross-sectional, case-control fMRI study involving two strictly matched groups (n = 32) based on gender, age, education, and years of practice. Seed-to-voxel analysis was performed using the Salience, and Frontoparietal Networks as seed regions in Stroop Word-Color and N-Back tasks and Resting State.

Results

During Resting State condition and using Salience network as a seed, Tai Chi group exhibited a stronger correlation between Anterior Cingulate Cortex and Insular Cortex areas (regions related to interoceptive awareness, cognitive control and motor organization of subjective aspects of experience). In N-Back task and using Salience network as seed, Tai Chi group showed increased correlation between Left Supramarginal Gyrus and various cerebellar regions (related to memory, attention, cognitive processing, sensorimotor control and cognitive flexibility). In Stroop task, using Salience network as seed, Tai Chi group showed enhanced correlation between Left Rostral Prefrontal Cortex and Right Occipital Pole, and Right Lateral Occipital Cortex (areas associated with sustained attention, prospective memory, mediate attention between external stimuli and internal intention). Additionally, in Stroop task, using Frontoparietal network as seed, Water Aerobics group exhibited a stronger correlation between Left Posterior Parietal Lobe (specialized in word meaning, representing motor actions, motor planning directed to objects, and general perception) and different cerebellar regions (linked to object mirroring).

Conclusion

Our study provides evidence of differences in functional connectivity between older adults who have received training in a mind-body practice (Tai Chi) or in an aerobic physical activity (Water Aerobics) when performing attentional and working memory tasks, as well as during resting state.

Traditional Chinese Rehabilitation Exercise (TCRE) for Myofascial Pain: Current Evidence and Further Challenges

Myofascial as a holistic structure emphasizes a holistic approach to intervention and treatment of fascial-related disorders such as neck pain (NP), low back pain (LBP), and knee pain. There are currently adverse effects of medication for diseases related to myofascial. Traditional Chinese rehabilitation exercise (TCRE) is a practical approach to traditional Chinese medicine and is a valuable option for intervening in myofascial-related pain. This article found some research evidence for Baduanjin, Wuqinxi, and Yijinjing in clinical studies of myofascial chain-related pain. The article summarizes the current evidence and finds that TCRE can enhance limb movement function through breathing and slow movements, increase joint movement and flexibility, and reduce joint pathology and stress-induced pain. As for future directions, focus on TCRE in improving the health of older adults and treating long-COVID syndrome, and integrate robotic and TCRE training to frame safe and effective exercise models. Relevant studies have already been registered in the Clinical Trials Registry, and some clinical study protocols have been published. TCRE can be an alternative nonpharmacological rehabilitation therapy to alleviate chronic rheumatic pain symptoms and augment public health management.

Distinct effects of long-term Tai Chi Chuan and aerobic exercise interventions on motor and neurocognitive performance in early-stage Parkinson's disease: a randomized controlled trial

BACKGROUND

Parkinson's disease (PD) is a neurodegenerative condition characterized by movement disorders and probable cognitive impairment. Exercise plays an important role in PD management, and recent studies have reported improvement in motor symptoms and cognitive function following aerobic and Tai Chi Chuan exercise.

AIM

To explore the different effects of Tai Chi Chuan and aerobic exercise on the clinical motor status and neurocognitive performance of patients with early-stage PD.

DESIGN

A randomized controlled trial.

SETTING

Parkinson's Disease Center at Kaohsiung Chang Gung Memorial Hospital and National Cheng Kung University Hospital.

POPULATION

Patients with idiopathic PD.

METHODS

Fifty-six patients with PD were recruited and divided into three groups: aerobic exercise (AE, N.=14), Tai Chi Chuan exercise (TE, N.=16), and control (CG, N.=13). Before and after a 12-week intervention period, we used unified Parkinson's disease rating scale Part III (UPDRS-III) scores and neuropsychological (e.g., accuracy rates [ARs] and reaction times [RTs]) and neurophysiological (e.g., event-related potential [ERP] N2 and P3 latencies and amplitudes) parameters to respectively assess the patients' clinical motor symptoms and neurocognitive performance when performing a working memory (WM) task.

RESULTS

Compared to baseline, UPDRS-III scores were significantly lower in the AE and TE groups after the intervention period, whereas those for the CG group were higher. In terms of the neurocognitive parameters, when performing the WM task after the intervention period, the AE group exhibited significantly faster RTs and larger ERP P3 amplitudes, the TE group exhibited an improvement only in ERP P3 amplitude, and the CG group exhibited a significantly reduced ERP P3 amplitude. However, neither the TE nor the AE group exhibited improved ARs and ERP N2 performance.

CONCLUSIONS

The present study supported the distinct effectiveness of Tai Chi Chuan and aerobic exercise for improving motor symptoms and providing neurocognitive benefits in PD patients.

CLINICAL REHABILITATION IMPACT

These results have important implications regarding the use of these exercise interventions for managing PD, particularly in the early stages.

The effect of Tai Chi/Qigong on depression and anxiety symptoms in adults with Cancer: A systematic review and meta-regression

OBJECTIVE

We expand on prior systematic reviews of Tai chi/Qigong (TCQ) practice on depression or anxiety symptoms in adults with cancer to estimate the mean effect of TCQ on depression and anxiety in randomized controlled trials. Additionally, we perform moderator analysis to examine whether effects vary based on patient features, TCQ stimuli properties, or characteristics of research design.

METHODS

Guided by PRISMA guidelines, we located articles published before August 31, 2023 using a combination of electronic database search and a complementary manual search through reference lists of articles and published reviews. Two separate multilevel meta-analyses with random-effects model were employed to estimate the overall effect of TCQ on depression and anxiety respectively. Further, multilevel meta-regression analysis was utilized to examine moderating effects based on moderators derived from patient features, TCQ stimuli properties, or characteristics associated with research design. Meta-analyses were performed in R4.0.0 and certainty of evidence with GRADEpro software.

RESULTS

The TCQ intervention yielded a standardized mean effect size of 0.29 (95% CI, 0.18 to 0.40) for anxiety, indicating homogeneity among the included studies. Conversely, for depression, the standardized mean effect size was 0.35 (95% CI, 0.14 to 0.55), signifying heterogeneity: reductions were larger when the trial primary outcome, predominantly function-related outcomes, changed significantly between the TCQ and control group.

CONCLUSIONS

TCQ practice exhibits small-to-moderate efficacy in alleviating depression and anxiety symptoms among cancer patients and survivors. Moreover, patients with depressive symptoms for whom TCQ intervention coupled with improvements in function-related outcomes manifested greater antidepressant effect.

The Positive Effects of Physical Activity on Quality of Life in Parkinson's Disease: A Systematic Review

BACKGROUND

Physical activity can have positive effects on motor and non-motor symptoms in Parkinson's disease, but its benefits in terms of quality of life and function are uncertain and vary based on the specific forms of activities and interventions.

OBJECTIVE

We sought to assess the current evidence on the positive effects of physical activity in people with Parkinson's disease and more specifically in relation to its potential benefits for quality of life.

METHODS

This systematic review was conducted between January and April 2024 via the PubMed, Medline, and Scopus databases. Predetermined search criteria were used that included the following terms: "Parkinson's disease", "quality of life" and "physical activity".

RESULTS

A total of 1669 articles were identified. After utilizing predetermined criteria, a total of fifteen articles met the selection criteria. Statistically significant improvements in quality of life were found in seven studies. Seven studies demonstrated a significant improvement in non-motor symptoms, while nine studies showed an improvement in motor symptoms.

CONCLUSIONS

Despite heterogeneity in the study designs, interventions and clinical assessments, the articles identified in this review yielded mostly positive results in relation to physical activities. The findings reflect an improvement in motor and non-motor symptoms may translate to a better quality of life in people with Parkinson's disease.

The effect of home-based exercise on motor and non-motor symptoms with Parkinson's disease patients: A systematic review and network meta-analysis

OBJECTIVE

To evaluate the effects of home-based exercise in Parkinson's disease (PD) patients.

DESIGN

A network meta-analysis of randomized controlled trials.

METHODS

This study systematically searched PubMed, MEDLINE, Embase, Cochrane library and Web of Science. The quality of the literature was assessed using the Cochrane Risk of Bias 2.0 criteria. The data were pooled using R software. Results are presented as pooled standardized mean difference (SMD) with 95% confidence interval (CI).

RESULTS

Thirty studies involving 2264 PD patients were included. Meta-analysis results showed that home-based exercise had a small effect in relieving overall motor symptoms in PD patients (SMD: -.28, 95% Crl [-.43; -.14]), improving quality of life (SMD = .15 [.03, .26]), walking speed (SMD = .30 [.04, .56]), balance ability (SMD = .18 [.04, .33]; p < .0001) and finger dexterity (SMD = .28 [.10, .46]). Mixed exercise (Mix) had better effects on improving motor symptoms and quality of life. In addition, the results of dose analysis showed that only mixed exercise exceeding 850 METs-min per week and more than 18 weeks can significantly alleviate the overall motor symptoms of PD patients.

CONCLUSION

Home-based exercise was an effective form of therapy for alleviating motor symptoms. In addition, Mix appeared to be more suitable for PD patients engaging in home-based exercise. Existing evidence suggested that significant therapeutic effects were achieved with a Mix, with a weekly exercise volume exceeding 850 METs and a duration of more than 18 weeks.

RELEVANCE TO CLINICAL PRACTICE

Home-based exercise had a small effect in relieving overall motor symptoms in PD patients, improving quality of life, walking speed, balance ability and finger dexterity. In terms of exercise dosage, we recommend the exercise period is no less than 18 weeks and the dose per is no less than 850 METs-min. No Patient or Public Contribution.

Identification of Prodromal Parkinson Disease: We May Be Able to But Should We?

Parkinson disease (PD) remains a progressive and incurable disease. Research over the past decade provides strong evidence of a detectible phase before the clinical diagnosis, known as the prodromal phase of PD (pPD). In this article, we review the debate about disclosure of risk of progression to PD and related disorders to individuals through the perspectives of the pillars of medical ethics: beneficence, nonmaleficence, autonomy, and justice. There is evidence that lifestyle modification may have positive effects on onset and progression of PD, providing justification of potential benefit. From a societal perspective, a diagnosis of pPD could allow targeted recruitment to disease-modifying trials. Regarding nonmaleficence, direct evidence that catastrophic reactions are scarce is largely derived from studies of monogenic conditions, which may not be generalizable. Diagnosis of PD can be traumatic, and appropriate communication and evaluation of circumstances to weigh up disclosure is crucial. Future research should therefore examine the potential harms of early and of false-positive diagnoses and specifically examine these matters in diverse populations. Autonomy balances the right to know and the right not to know, so an individualized patient-centered approach and shared decision-making is essential, acknowledging that knowledge of being in the prodromal phase could prolong autonomy in the longer term. Distributive justice brings focus toward health care and related planning at the individual and societal level and affects the search for disease modification in PD. We must acknowledge that waiting for established disease states is likely to be too little, too late and results in failures of expensive trials and wasted participant and researcher effort. Ultimately, clinicians must arrive at a decision with the patient that solicits and integrates patients' goals, taking into account their individual life circumstances, perspectives, and philosophies, recognizing that one size cannot fit all.

Stress reduction through taiji: a systematic review and meta-analysis

PURPOSE

In light of the mounting prevalence of stress in contemporary society and the growing interest in stress reduction methods, this review investigates the potential of taiji as a viable strategy for alleviating stress.

METHODS

MEDLINE, EMBASE, the Cochrane Controlled Trials Register (CENTRAL), PsycINFO, and Web of Science were searched up to April 2023 to identify randomized controlled trials of taiji. Studies in both patients and healthy populations were considered. They had to provide a measure of perceived stress and include a no treatment or placebo control group. Data were extracted by two reviewers. Pooled standardized mean differences (SMD) were calculated for perceived stress, biological stress markers, anxiety, depression, and quality of life (QoL). Meta-regression analyses were performed to identify sources of heterogeneity.

RESULTS

Eleven trials with a total of 1323 patients comparing taiji to no intervention met the inclusion criteria. The included studies varied strongly with regard to patient characteristics, taiji intervention, and methodological quality. The overall SMD for perceived stress was significant at -0.41 (95% confidence interval, CI, -0.63 to -0.19; I2 = 63%). Exclusion of studies with less than 100 participants yielded a diminished SMD at -0.26 (95% CI, -0.45 to -0.06). The SMD for perceived stress at follow-up was significant (-0.25, 95% CI -0.46 to -0.05). Secondary outcomes highlighted improvements in anxiety and physical QoL, while depression, mental QoL, and biological stress markers remained unchanged.

CONCLUSIONS

Results underscore taiji's potential in mitigating perceived stress in both patients and healthy populations, paralleled by enhancements in depressive symptoms, anxiety levels, and physical QoL.

Evaluating qigong as integrative support for COVID-19 and Long-COVID-19 rehabilitation: a systematic review

Introduction

Amidst the ongoing global impact of COVID-19 on public health, there is an increasing focus on holistic strategies encompassing integrative therapies and rehabilitation techniques, particularly in addressing the challenges posed by Long-COVID-19. This review investigates the potential of Qigong, an ancient Chinese practice characterized by gentle movements, controlled breathing, and meditative elements, within the context of COVID-19.

Methods

A systematic search of PubMed, EMBASE, Web of Science, Scopus, and Google Scholar was conducted to identify pertinent clinical studies.

Results

Following thorough database scrutiny, nine studies were identified as meeting the eligibility criteria. Across the spectrum of COVID-19 severity, individuals engaging in qigong practice exhibited notable enhancements in both physical and psychological wellbeing, evidenced by ameliorated respiratory symptoms, reduced anxiety levels, enhanced sleep quality, bolstered mental wellbeing, and augmented health-related quality of life. Moreover, qigong training, whether employed independently or in conjunction with other therapies, demonstrated beneficial effects on Long-COVID-19 symptoms, encompassing persistent respiratory issues, dizziness, sleep disturbances, and compromised health-related quality of life.

Discussion

This review underscores the necessity for further investigation to quantify and standardize the contribution of Qigong to COVID-19 recovery and rehabilitation. Such endeavors aim to integrate this accessible and low-impact practice into public health strategies and comprehensive treatment regimens.

Systematic review registration

The review protocol was registered in the Open Science Framework under the following doi: 10.17605/OSF.IO/7K5X6 (URL: https://osf.io/7k5x6).

Effect of Boxing Exercises on the Functional Ability and Quality of Life of Individuals with Parkinson's Disease: A Systematic Review

Parkinson's disease (PD) is a neurological disorder caused by the loss of dopamine-producing cells in the substantia nigra and characterized by motor and non-motor symptoms. Boxing is a type of complementary therapy to improve symptoms in PD. The purpose of the present study was to examine the effect of boxing training on the functionality and quality of life of patients with PD. The literature search was performed on PubMed, Scopus, PEDro, Cochrane Library, and Google Scholar search engines. The PEDro scale was used to assess the methodological quality of the studies. This systematic review included three studies that examined disease severity, mobility, physical activity, balance, and quality of life. According to the PEDro scale criteria, the three articles included were of high methodological quality. Statistically significant improvements after the implementation of boxing training was shown for balance and quality of life in contrast to the other variables. Boxing training intervention programs had a positive effect on balance and quality of life in patients with PD; however, the results are conflicting regarding certain functionality variables. Therefore, it is necessary to conduct further research to examine the effectiveness of boxing training on the functionality and quality of life of patients with Parkinson's disease.

Rehabilitative effects of Baduanjin in Chinese stroke patients: A systematic review and meta-analysis

Objective

This study aims to systematically assess the rehabilitative effects of Baduanjin in stroke patients.

Methods

Ten electronic databases were systematically searched using MeSH and free terms for relevant studies written in the English or Chinese language, and published on or before 15 February 2023. Studies in which Baduanjin was the only difference in treatment administered to experimental and control groups were included in the review. The studies' risk of bias was evaluated using the Cochrane criteria.

Results

Twenty one studies that involved 1,649 participants were included. Compared to the control group, Baduanjin increased the scores for the Fugl-Meyer Assessment (including both upper and lower extremity components), Berg Balance Scale, Trunk Impairment Scale, Functional Ambulation Categories, 6-minute Walking Distance, Modified Barthel Index, Barthel Index, and total effective rate, but reduced the scores for the Pk254 balance function detection system, National Institutes of Health Stroke Scale and neurological deficit scale (P < 0.05, for all).

Conclusion

The present study findings revealed the potential benefits of Baduanjin in improving movement, balance, trunk, ambulation and neurological functions, and the ability to perform activities of daily living in stroke patients. Larger randomized controlled trials with more standardized intervention protocols are required to obtain more robust evidence.

Non-pharmacological therapies for treating non-motor symptoms in patients with Parkinson's disease: a systematic review and meta-analysis

Objective

The non-motor symptoms of Parkinson's disease (PD) are an important part of PD. In recent years, more and more non-drug interventions have been applied to alleviate the non-motor symptoms of PD, but the relevant evidence is limited. This systematic review and meta-analysis was designed to evaluate the efficacy of non-drug interventions in patients with non-motor symptoms in patients with PD.

Methods

Seven databases, including Pubmed, Embease, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database (WANFANG), VIP database (VIP), and China Biomedical Literature Service System (CBM) were searched from the establishment of the database to December 2023. Non-drug interventions such as acupuncture, cognitive behavioral therapy (CBT), exercise, repetitive transcranial magnetic stimulation (rTMS), and non-motor symptoms of Parkinson's disease were selected as search words, and two independent evaluators evaluated the included literature's bias risk and data extraction. The therapeutic efficacy was evaluated by the Parkinson's Disease Sleep Scale (PDSS), Hamilton Depression Scale (HAMD), Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAMA), Montreal Cognitive Assessment (MoCA), Minimum Mental State Examination (MMSE), and Parkinson's Disease Questionnaire-39 (PDQ-39). RevMan 5.4.1 (Reviewer Manager Software 5.4.1). Cochrane Collaboration, Oxford, United Kingdom analyzed the data and estimated the average effect and the 95% confidence interval (CI). A heterogeneity test is used to assess differences in the efficacy of different non-drug treatments.

Results

We selected 36 from 4,027 articles to participate in this meta-analysis, involving 2,158 participants. Our combined results show that: PDSS: [mean difference (MD) = -19.35, 95% CI (-30.4 to -8.28), p < 0.0006]; HAMD: [MD = -2.98, 95% CI (-4.29 to -1.67), p < 0.00001]; BDI: [MD = -2.69, 95% CI (-4.24 to 4.80), p = 0.006]; HAMA: [MD = -2.00, 95% CI (-2.83 to -1.17), p < 0.00001]; MMSE: [MD = 1.20, 95% CI (0.71 to 1.68), p < 0.00001]; CoMA: [MD = 2.10, 95% CI (-0.97 to 3.23), p = 0.0003]; PDQ-39: [MD = -4.03, 95% CI (-5.96 to -1.57), p < 0.00001].

Conclusion

The four non-drug measures used in our review showed significant improvements in sleep, depression, anxiety, cognition, constipation, and quality of life compared with the control group, and no serious adverse events were reported in the included research evidence, and we found that there were some differences among the subgroups of different intervention methods, but due to the less literature included in the subgroup, and the comparison was more indirect. So, we should interpret these results carefully.

Systematic review registration

www.crd.york.ac.uk/PROSPERO, identifier CRD42023486897.

Effect of Qigong exercise on motor function in stroke patients: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Motor impairment is one of the most common defects after stroke, which could seriously affect the life quality of stroke patients. Exercise intervention gradually becomes a popular alternative rehabilitation therapy because of its safety and applicability.

OBJECTIVES

To systematically assess the effect of Qigong exercise on motor function in stroke patients.

METHODS

Randomized controlled trials that evaluated the effect of Qigong on motor function of stroke patients were obtained from PubMed and Chinese National Knowledge Infrastructure through May 2022. Mean values and standard deviations of the post-intervention score in both experimental group and control group were collected to calculate the mean difference (MD) and corresponkding 95% confidence interval (95% CI) of each study, which were quantificationally summarized using the Review Manager 5.3 software.

RESULTS

Nineteen randomized controlled trials enrolling 1487 stroke patients were included. Pooled results indicated that Qigong exercise had beneficial effect on balance function (Berg Balance Scale [MD: 7.56, 95% CI: 4.09-11.02]), limb motor function (Fugl-Meyer Assessment [total score: MD: 7.54, 95% CI: 6.38-8.69; upper limb: MD: 3.57, 95% CI: 0.71-6.43; lower limb: MD: 2.44, 95% CI: 0.59-4.29]) and walking function (6-min walking test [MD: 62.21, 95% CI: 11.70-112.73]) of stroke patients. It was also found to be associated with an improvement in trunk function as indicated by the Trunk Impairment Scale.

CONCLUSIONS

Available evidence supported potential benefits of Qigong exercise for improving motor functions of stroke patients. As a safe and widely applicable exercise, Qigong is worthy of further promotion in the rehabilitation of stroke patients.

Mind over Microbes: Investigating the Interplay between Lifestyle Factors, Gut Microbiota, and Brain Health

BACKGROUND

The gut microbiota (GM) of the human body comprises several species of microorganisms. This microorganism plays a significant role in the physiological and pathophysiological processes of various human diseases.

METHODS

The literature review includes studies that describe causative factors that influence GM. The GM is sensitive to various factors like circadian rhythms, environmental agents, physical activity, nutrition, and hygiene that together impact the functioning and composition of the gut microbiome. This affects the health of the host, including the psycho-neural aspects, due to the interconnectivity between the brain and the gut. Hence, this paper examines the relationship of GM with neurodegenerative disorders in the context of these aforesaid factors.

CONCLUSION

Future studies that identify the regulatory pathways associated with gut microbes can provide a causal link between brain degeneration and the gut at a molecular level. Together, this review could be helpful in designing preventive and treatment strategies aimed at GM, so that neurodegenerative diseases can be treated.

Changes of brain-derived neurotrophic factor (BDNF) levels after different exercise protocols: a systematic review of clinical studies in Parkinson's disease

Background: Brain-Derived Neurotrophic Factor (BDNF) serum levels are reduced in patients with Parkinson's Disease (PD). Objectives: This study aimed to assess the effect of exercise intensity, volume and type on BDNF levels in patients with PD. Methods: We searched clinicaltrials.gov, CINAHL, Embase, PubMed, Scopus, Web of Science for both controlled and non-controlled studies in patients with PD, published between 2003 and 2022, which assessed Brain-Derived Neurotrophic Factor before and after different exercise protocols. Exercise intensity was estimated using a time-weighted average of Metabolic Equivalent of Task (MET), while exercise volume was estimated by multiplying MET for the duration of exercise. Exercise types were classified as aerobic, resistance, balance and others. We computed two distinct standardized measures of effects: Hedges' g to estimate differences between experimental and control group in pre-post intervention BDNF changes, and Cohen's d to measure pre-post intervention changes in BDNF values for each study arm. Meta-regression and linear regression were used to assess whether these effect measures were associated with intensity, volume and type. PROSPERO registration number: CRD42023418629. Results: Sixteen studies (8 two-arm trials and 8 single-arm trials) including 370 patients with PD were eligible for the systematic review. Selected studies had a large variability in terms of population and intervention characteristics. The meta-analysis showed a significant improvement in BDNF levels in the exercise group compared to the control group, Hedges' g = 0.70 (95% CI: 0.03, 1.38), with substantial heterogeneity (I2 = 76.0%). Between-group differences in intensity were positively associated with change in BDNF in a subset of 5 controlled studies. In the analysis which included non-controlled studies, intensity and total exercise volume were both positively associated with BDNF change. No difference was found according to exercise type. Conclusion: Exercises of greater intensity may increase BDNF levels in patients with PD, while the role of volume of exercise needs to be further explored.

The Effectiveness of Inpatient Rehabilitation in Parkinson's Disease: A Systematic Review of Recent Studies

Background

Parkinson's disease (PD) is a progressive disease, which is associated with the loss of activities of daily living independency. Several rehabilitation options have been studied during the last years, to improve mobility and independency.

Objective

This systematic review will focus on inpatient multidisciplinary rehabilitation (MR) in people with Parkinson's disease (PwPD), based on recent studies from 2020 onwards.

Methods

Search strategy in three databases included: multidisciplinary rehabilitation, Parkinson's Disease, inpatient rehabilitation, motor-, functional- and cognitive performance, cost-effectiveness, Quality of Life, and medication changes/Levodopa equivalent daily doses.

Results

Twenty-two studies were included, consisting of 13 studies dealing with inpatient MR and 9 studies on inpatient non-MR interventions. Inpatient PD multidisciplinary rehabilitation proved to be effective, as well as non-MR rehabilitation.

Conclusions

This review confirms the efficacy of inpatient MR and non-MR in PD, but is skeptical about the past and current study designs. New study designs, including new physical training methods, more attention to medication and costs, new biomarkers, artificial intelligence, and the use of wearables, will hopefully change rehabilitation trials in PwPD in the future.

Effects of 3-month Qigong exercise on heart rate variability and respiration in anxious college students

OBJECTIVE

This longitudinal study aimed to investigate the effects of Qigong on the anxiety state, heart rate variability (HRV), and breathing of anxious college students.

METHODS

A total of 37 individuals (18-25 years old) were randomly allocated to the control (n = 19) and intervention (n = 18) groups. Qigong interventions were conducted five times weekly for 12 weeks, with each session lasting 60 min. Hamilton Anxiety Scale, Fatigue Scale 14, Pittsburgh Sleep Quality Index, and 36-item Short Form Survey, HRV, and respiration data were collected before and after the 3-month intervention.

RESULTS

Individuals who participated in the three-month Qigong exercise intervention showed a significant reduction in anxiety, particularly mental anxiety (p < 0.05). Subjects in the intervention group presented a decrease in skin temperature (p < 0.05) and an increase in blood volume pulsation (p < 0.05). Meanwhile, HRV exhibited a significant increase in the standard deviation of interbeat interval before and after comparisons (p < 0.05) and between the two groups (p = 0.039) and a reduction in the normalized low-frequency power after the intervention. Moreover, the intervention group experienced increased abdominal breathing depth and abdominal breathing per minute (p < 0.05).

CONCLUSION

These findings indicate that Qigong is an effective mind-body exercise strategy for relieving anxiety. HRV and breathing were improved accordingly among college students after the completion of the 3-month Qigong program.

Considerations on How to Prevent Parkinson's Disease Through Exercise

The increasing prevalence of people with Parkinson's disease (PD) necessitates a high priority for finding interventions to delay or even prevent the onset of PD. There is converging evidence that exercise may exert disease-modifying effects in people with clinically manifest PD, but whether exercise also has a preventive effect or is able to modify the progression of the pathology in the prodromal phase of PD is unclear. Here we provide some considerations on the design of trials that aim to prevent PD through exercise. First, we discuss the who could benefit from exercise, and potential exercise-related risks. Second, we discuss what specific components of exercise mediate the putative disease-modifying effects. Third, we address how methodological challenges such as blinding, adherence and remote monitoring could be handled and how we can measure the efficacy of exercise as modifier of the course of prodromal PD. We hope that these considerations help in designing exercise prevention trials for persons at risk of developing PD.

The therapeutic effects of yoga in people with Parkinson's disease: a mini-review

Parkinson's disease (PD) is one of the most common neurodegenerative diseases, second only to Alzheimer's disease. Drugs and deep brain stimulation (DBS) are the main treatments for PD. However, the long-term side effects of drugs and the risks of surgery cannot be ignored. It is therefore important to research safe and effective complementary and alternative therapies for PD. Yoga, an ancient mind-body exercise, has been widely used in health promotion. Although, yoga can address a range of health problems, little is known about its role in people with PD. This article reviews the evidence that yoga improves PD symptoms, including movement disorders, balance function and emotional disturbance. The authors analyze the role and shortcomings of the yoga intervention process, with the aim of providing a scientific basis for the application of yoga training to people with PD.

Physical exercise and its effects on people with Parkinson's disease: Umbrella review

INTRODUCTION

Parkinson's disease is neurodegenerative, complex and progressive, manifesting in a slow and irreversible way. Physical exercise has been proposed as therapeutic alternative to people with Parkinson´s disease.

OBJECTIVE

To synthesize knowledge about the effects of physical exercise on people with Parkinson´s Disease as presented by published systematic reviews.

METHODS

Nine electronic databases and two grey literature databases were searched for systematic reviews reporting the effects of physical exercises on people with Parkinson´s Disease. Searches involved a two-phase process, by, at least, two independent reviewers. Methodological quality of the included systematic reviews was assessed using AMSTAR-2.

RESULTS

From 2,122 systematic reviews, 139 were included. Motor outcomes were assessed in 91% of the studies, with balance being the most studied. Non-motor outcomes were assessed in 68% of the studies, with emphasis on quality of life. Physical exercises were classified into five categories: aerobic exercises, strength, combined, sensorimotor activities and other activity protocols. Findings of the systematic reviews suggest that all exercise categories can be prescribed to improve balance and mobility, while combined exercises, strength, and specific activities improve both motor and non-motor outcomes, and aerobic exercise and sensorimotor activities improve motor outcomes.

CONCLUSION

Current evidence from systematic reviews suggests that physical exercises impacts both motor and non-motor outcomes in people with Parkinson´s Disease. Limits in evidence provided by the systematic reviews were related to methodological issues and to the description of the interventions and must be considered to improve decision-making and clinical application.

Updates in Parkinson's Disease Integrative Therapies: an Evidence-Based Review

PURPOSE OF REVIEW

This review summarizes recent evidence-based integrative therapies for Parkinson's disease (PD) that may improve motor and non-motor symptoms, enhance quality of life, and alter disease progression.

RECENT FINDINGS

Imaging studies have demonstrated that aerobic exercise changes brain structure and function, while strength training improves posture and balance. Loneliness is associated with worsening PD severity, but social prescribing and cognitive behavioral therapy may effectively foster connections. Ayurvedic and traditional Chinese medicine practices including yoga, meditation, tai chi, and acupuncture may help improve mobility, mood, sleep, and quality of life. Art therapy enhances visuospatial skills, whereas music and dance therapy can alleviate freezing of gait. Several studies demonstrate successful use of these integrative strategies virtually, thereby improving patient accessibility and participation. PD management has broadened to include integrative approaches combining conventional and complementary therapies. Potential benefits of movement, nutrition, sleep, socialization, and mind-body practices have been confirmed with several recent randomized controlled trials.

Sustained practice of Qigong results in a somatic hermeneutic process, contributing to appreciation of life. An interpretative phenomenological analysis

Over the past few decades evidence has accumulated into the health benefits of practising Qigong, particularly in the amelioration of physical conditions. Previous studies have been conducted using positivist biomedical model methodologies, which may be limited in understanding the nuanced meaning-making and embodied experience of practitioners. This study uses Interpretative Phenomenological Analysis (IPA) to inquire into how the sustained practice of Qigong contributes beyond the relief of physical conditions to improved self-awareness and appreciation of life. Semi-structured interviews were conducted with five Qigong practitioners who each had over 10-years' experience and analysed using the interpretive methodology of IPA. Findings reveal a crucial antecedent theme of 'Openness to experience' and four, interrelated, super-ordinate themes common to each of the participants: 'Finding a Teacher', 'Bodymind' (proprioception and interoception), 'Primary Process of Developmental Change', and 'Awareness of emergent Authenticity'. Insights revealed how each practitioner makes sense of the sustained 'autotelic' practice of Qigong, and how this contributes to a transformative understanding of themselves and of life. Qigong presents a possible promising intervention to improve both physical and psychological well-being.

Effect of Physiotherapy Interventions on Motor Symptoms in People With Parkinson's Disease: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the effectiveness of different types of physiotherapy interventions in people with Parkinson's disease (PD).

DESIGN

Systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

Five databases (PubMed, Embase, Cochrane Library, CINAHL and Web of Science Core Collection) were searched for relevant RCTs published from database inception to July 14, 2022. Reviewers independently screened the literature, extracted data, and assessed the literature quality according to the Cochrane Collaboration Risk of Bias Tool and PEDro Scale. This meta-analysis was conducted using RevMan 5.4.1 and reported in compliance with the PRISMA statement.

RESULTS

Forty-two RCTs with 2,530 participants were included. Across all types of physiotherapy, strength training, mind-body exercise, aerobic exercise, and non-invasive brain stimulation (NiBS) were effective in improving motor symptoms as measured by the (Movement Disorders Society-) Unified PD Scale, whereas balance and gait training (BGT) and acupuncture were not. The pooled results showed that the change in mind-body exercise (MD = -5.36, 95% CI [-7.97 to -2.74], p < .01, I2 = 68%) and NiBS (MD = -4.59, 95% CI [-8.59 to -0.59], p = .02, I2 = 78%) reached clinical threshold, indicating clinically meaningful improvements. Considering the effectiveness of the interventions on motor symptoms, balance, gait and functional mobility, mind-body exercise was recommended the most.

CONCLUSIONS

Exercise appears to be a better form of physiotherapy than NiBS and acupuncture for improving motor function. Mind-body exercise showed beneficial effects on motor symptoms, balance, gait and functional mobility in people with PD, and is worthy of being promoted.

Effects of tai chi on postural balance and quality of life among the elderly with gait disorders: A systematic review

BACKGROUND

Tai Chi is good for improving the physical fitness of older adults. But few studies have reported the effects of Tai Chi on the postural balance and quality of life of older adults with gait disorders.

OBJECTIVE

This review aimed to assess the influence of tai chi on postural stability and quality of life in older adults with abnormal gait.

METHOD

According to the literature retrieval principles, the works published from the inception date to May 2023 were retrieved, including the following databases: PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, EBSCOhost, and Google Scholar. Subsequently, literature screening and quality assessment were performed.

RESULTS

A total of 16 randomized controlled trials were included in this study, Tai Chi intervention can affect populations with Parkinson's disease (PD), no exercise, mild cognitive impairment (MCI), chronic stroke, sedentary, fear of falling, or history of falling. Postural instability is associated with balance, gait, the Unified Parkinson's Disease Rating Scale Motor Subscale 3 (UPDRS III), mobility, lower body strength, and falls. Only two articles looked at quality of life. The Yang style is the most commonly used in the intervention. Nonetheless, most studies were performed on female participants, hence, more research on older male populations is needed.

CONCLUSION

Tai Chi intervention benefits postural balance in patients with gait disorders. 12 weeks is the most common intervention period for patients with gait disorders. The frequency of intervention is seven articles twice a week, and the intervention time is about 60 minutes. The Tai Chi intervention methods in this study involve Yang Style, Sun Style, Taoist Tai Chi, and Health Qigong Tai Chi, but the Yang Style Tai Chi intervention is the most widely used.

Comparative efficacy of 24 exercise types on postural instability in adults with Parkinson's disease: a systematic review and network meta-analysis

OBJECTIVE

To compare, rank and evaluate the 24 exercise types that improve postural instability in patients with Parkinson's disease (PD).

METHODS

We searched the data in PubMed, MEDLINE, Embase, PsycINFO, Cochrane library, and Web of Science from their inception date to January 23, 2023. Randomized controlled trials (RCTs) that aimed at determining the effectiveness of physical activity interventions on postural instability in adults with PD. This review focused on different balance outcome categories: (a) balance test batteries (BBS); (b) static steady-state balance (sSSB); (c) dynamic steady-state balance (dSSB); (d) proactive balance (PB); (e) reactive balance (RB).

RESULTS

Among 10,474 records, 199 studies (patients = 9523) were eligible for qualitative synthesis. The random-effects NMA model revealed that the following exercise training modalities had the highest p score of being best when compared with control group: body-weight support treadmill training (BWS_TT) for BBS (p score = 0.97; pooled standardised mean difference (95% CI): 1.56 (0.72 to 2.39)) and dSSB (1.00; 1.53 (1.07 to 2.00)), aquatic exercise (AQE) for sSSB (0.85; 0.94 (0.33 to 1.54)), Pilates for PB (0.95; 1.42 (0.59 to 2.26)). Balance and gait training with the external cue or attention (BGT_ECA) and robotic assisted gait balance (RA_GT) had similar superior effects in improving RB. The confidence in evidence was often low according to Confidence in Network Meta-Analysis.

CONCLUSIONS

There is low quality evidence that BWS_TT, AQE, Pilates, BGT_ECA and RA_GT are possibly the most effective treatments, pending outcome of interest, for adults with PD.

Rehabilitation for non-motor symptoms for patients with Parkinson's disease from an α-synuclein perspective: a narrative review

Parkinson's disease (PD) is a common neurodegenerative disorder affecting aged population around the world. PD is characterized by neuronal Lewy bodies present in the substantia nigra of the midbrain and the loss of dopaminergic neurons with various motor and non-motor symptoms associated with the disease. The protein α-synuclein has been extensively studied for its contribution to PD pathology, as α-synuclein aggregates form the major component of Lewy bodies, a hallmark of PD. In this narrative review, the authors first focus on a brief explanation of α-synuclein aggregation and circumstances under which aggregation can occur, then present a hypothesis for PD pathogenesis in the peripheral nervous system (PNS) and how PD can spread to the central nervous system from the PNS via the transport of α-synuclein aggregates. This article presents arguments both for and against this hypothesis. It also presents various non-pharmacological rehabilitation approaches and management techniques for both motor and non-motor symptoms of PD and the related pathology. This review seeks to examine a possible hypothesis of PD pathogenesis and points to a new research direction focus on rehabilitation therapy for patients with PD. As various non-motor symptoms of PD appear to occur earlier than motor symptoms, more focus on the treatment of non-motor symptoms as well as a better understanding of the biochemical mechanisms behind those non-motor symptoms may lead to better long-term outcomes for patients with PD.

Pharmacological and Non-Pharmacological Treatments for Depression in Parkinson's Disease: An Updated Review

Depression represents one of the most common non-motor disorders in Parkinson's disease (PD) and it has been related to worse life quality, higher levels of disability, and cognitive impairment, thereby majorly affecting not only the patients but also their caregivers. Available pharmacological therapeutic options for depression in PD mainly include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants; meanwhile, agents acting on dopaminergic pathways used for motor symptoms, such as levodopa, dopaminergic agonists, and monoamine oxidase B (MAO-B) inhibitors, may also provide beneficial antidepressant effects. Recently, there is a growing interest in non-pharmacological interventions, including cognitive behavioral therapy; physical exercise, including dance and mind-body exercises, such as yoga, tai chi, and qigong; acupuncture; therapeutic massage; music therapy; active therapy; repetitive transcranial magnetic stimulation (rTMS); and electroconvulsive therapy (ECT) for refractory cases. However, the optimal treatment approach for PD depression is uncertain, its management may be challenging, and definite guidelines are also lacking. It is still unclear which of these interventions is the most appropriate and for which PD stage under which circumstances. Herein, we aim to provide an updated comprehensive review of both pharmacological and non-pharmacological treatments for depression in PD, focusing on recent clinical trials, systematic reviews, and meta-analyses. Finally, we discuss the pharmacological agents that are currently under investigation at a clinical level, as well as future approaches based on the pathophysiological mechanisms underlying the onset of depression in PD.

Parkinson's Disease Related Depression and Anxiety: A 22-Year Bibliometric Analysis (2000-2022)

Background

Parkinson's disease (PD) is one of the common neurodegenerative diseases. Depression and anxiety are the most common psychiatric symptoms of PD. It is important to study the potential relationship between PD and depression or anxiety.

Aim

This study aimed to use bibliometrics to analyze the papers about parkinson's disease related depression and anxiety over the last 22 years, and to characterize the current status of research and predict future hotspots.

Methods

In the Web of Science Core Collection (WoSCC) from 2000 to 2022, documents are searched according to specific subject words. The selected literature was retrospectively analyzed and mapped using CiteSpace and Vosviewer software. We analyzed countries, institutions, journals, authors, references and keywords.

Results

A total of 7368 papers were included from 2000 to 2022, and the number of publications has shown an upward trend year by year. Movement Disorder is the journal with the highest number of publications (391 publications, 5.31%) and citations (30,549 times), with the United States (2055 publications, 27.9%) and the University of Toronto (158 publications) being the countries and institutions with the highest number of publications. The high-frequency keywords focused on "quality of life", "deep brain stimulation" and "non-motor symptoms". "Functional connectivity", "gut microbiota" and "inflammation" may be at the forefront of future research.

Conclusion

Parkinson's disease related depression and anxiety have been increasingly studied over the past 22 years. Functional connectivity, gut microbiota, and inflammation will be the subject of active research hotspots in the future, and these findings may provide new research ideas for researchers.